Background <p>Targeted axillary dissection (TAD) is a less invasive alternative to axillary lymph node dissection (ALND) for patients with clinically node-positive breast cancer who convert to node-negative status after neoadjuvant chemotherapy (NAC). However, the effect of preoperative ultrasound visibility of different clip types on TAD outcomes remains unclear.</p> Methods <p>We conducted a single-center retrospective cohort study of patients with biopsy-proven axillary node-positive breast cancer who underwent NAC followed by TAD between August 2017 and December 2024. Two ultrasound-visible clips, the UltraCor™ Twirl™ (Twirl) and HydroMARK™, were evaluated. Outcomes included ultrasound visibility, clipped node retrieval success, localization techniques, and false-negative rate (FNR).</p> Results <p>Twenty-nine patients were included (Twirl, <i>n</i> = 15; HydroMARK, <i>n</i> = 14). Ultrasound visibility was higher with Twirl than with HydroMARK (86.7% versus 64.3%; <i>p</i> = 0.330). All Twirl cases underwent combined wire and dye-guided localization, whereas HydroMARK cases used multiple localization techniques. Retrieval success reached 100% with Twirl and 78.6% with HydroMARK (<i>p</i> = 0.199). When clips were visible on ultrasound, retrieval rates were high for both clips at 100% for Twirl and 88.9% for HydroMARK (<i>p</i> = 0.850). When clips were not clearly visible, Twirl maintained 100% retrieval compared with 60.0% for HydroMARK (<i>p</i> = 0.895). Among patients who underwent scheduled ALND, the FNR of TAD was 0% (0/6).</p> Conclusions <p>Preoperative ultrasound visibility of the clip was associated with successful clip-based TAD. Twirl showed more consistent ultrasound visibility and retrieval success than HydroMARK, which suggests that Twirl may be a more reliable clip for routine clinical practice.</p>